Management Of Cardiovascular Complications Research Articles

Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults

Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an acquired autoimmune and procoagulant condition that predisposes individuals to recurrent thrombotic events and obstetric complications. Central is the role of three types of antiphospholipid antibodies that target phospholipid-binding proteins: lupus anticoagulant (LAC), anti-β2-glycoprotein I (β2-GPI-Ab), and anti-cardiolipin (aCL). Together with clinical data, these antibodies are the diagnostic standard. However, the diagnosis of APS in older adults may be challenging and, in the diagnostic workup of thromboembolic complications, it is an underestimated etiology. The therapeutic management of APS requires distinguishing two groups with differential risks of thromboembolic complications. The standard therapy is based on low-dose aspirin in the low-risk group and vitamin K antagonists in the high-risk group. The value of direct oral anticoagulants is currently controversial. The potential role of monoclonal antibodies is investigated. For example, rituximab is currently recommended in catastrophic antiphospholipid antibody syndrome. Research is ongoing on other monoclonal antibodies, such as daratumumab and obinutuzumab. This narrative review illustrates the pathophysiological mechanisms of APS, with a particular emphasis on cardiovascular complications and their impact in older adults. This article also highlights advancements in the diagnosis, risk stratification, and management of APS.

New Approaches to Cardiovascular Toxicity Assessment in Patients with Hematological Malignancies: A Literature Review

Since 2016, the management of cardiovascular complications has been guided by a few documents that are based on the recommendations of the European Society of Cardiology and are regularly updated. The present literature review deals with algorithms of diagnosis and correction of cardiovascular adverse events occurring on or after drug chemotherapy in patients with hematological malignancies. The aim of this paper is to analyze the literature data on optimizing the management of chemotherapy recipients, improving their quality of life as well as reducing mortality due to drug therapy-related cardiovascular complications.

Anesthetic Management of Esophagectomy using one Lung Ventilation

Introduction: Esophagectomy is considered as procedure with highest morbidity and mortality; yet one of the main stream treatment for esophageal cancers. Genetics, age, sex, gender are unmodifiable risk factors for esophageal cancers, it is one of the most common cancers occurring in the world. Most important features of oesophagectomy are perioperative risk assessment, pulmonary morbidity, ventilation strategies, thoracic epidural analgesia, goal directed fluid therapy, ERAS protocol, management of cardiovascular complications. Thoracic epidural analgesia helps in reducing the systemic inflammatory response, by decreasing pain stimulus and post-operative pain control. Case Report: A 62 year old, 50 kgs man was posted for transthoracic esophagectomy presented with complaints of difficulty in swallowing and generalized weakness. Patient medical history was not significant. Patient had received 4 cycles chemotherapy (paclitaxel and carboplatin). Anaesthetic management was planned with the aim of proper analgesia, minimum respiratory complications following ERAS protocol. Conclusion: Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative “protective anesthesia”. Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient’s condition, the type of surgery endured and the availability of local resources.

Effect of Solvent Extracts of Tephrosia vogelii Leaves and Stem on Lipid Profile of Poloxamer 407-Induced Hyperlipidemic Rats

Abstract Introduction There are claims by traditional medicine practitioners in Nigeria and valuable scientific reports that the leaves of Tephrosia vogelii (TV) hook are used for the treatment of various diseases; however, there is paucity of information on it used in the management of cardiovascular complications despite the rich presence of phytochemicals. This study aimed at investigating effects of solvents extracts of TV leaves and stem on lipid profile of poloxamer 407-induced hyperlipidemic rats. Materials and Methods Varying doses of the solvent extracts (water, ethanol, and acetic acid) of plant material were administered to experimental animals (Albino Wistar rats) induced with hyperlipidemia using poloxamer 407 (P-407). Results The results of the phytochemical screening of leaves and stem revealed the presence of alkaloids, saponins, phlobatannins, and flavonoids in powdered sample of leaves and stem of TV. Aqueous extract of the leaves had the highest yield (18.21 ± 1.12%), while acetic acid extract of stem had the lowest yield (7.21 ± 1.21%). The cholesterol and triacylglycerol level of rats induced with P-407 was significantly (p≤0.05) higher than normal rats. This study showed that aqueous extract at 50mg/kg body weight significantly (p≤0.05) lower cholesterol, low-density lipoprotein, very low-density lipoprotein, and triacylglycerol levels. Indices of cardiovascular function atherogenic coefficient, atherogenic index, coronary risk index, and cardioprotective index were positively modulated by the treatment. Conclusion The study indicated that the aqueous leaves extract of TV possesses antihyperlipidemic effects and may explains why it has been found to be useful in the management of cardiovascular diseases by traditional medicine practitioners.

Cardiovascular toxic effects of antitumor agents: Pathogenetic mechanisms

Cancer treatment is associated with various side effects of antitumor agents, which increase the morbidity and mortality of these patients. Cardiovascular complications are considered to be one of the most important side effect of the anticancer drugs. The antitumor drugs that express cardiovascular effects include anthracyclines, tyrosine kinase inhibitors, taxanes, fluoropyrimidines, alkylating agents, vascular endothelial growth factor inhibitors, immune checkpoint inhibitors, proteasome inhibitors and human epidermal growth receptor type 2 antibodies. The spectrum of cardiovascular effects of anticancer drugs is broad and include, among others, heart failure, arrhythmias such as atrial fibrillation and ventricular tachyarrhythmias, hypertension (systemic or pulmonary), cardiomyopathy, myocarditis, valve disease, pericardial disease, vascular events (arterial thrombosis, venous thromboembolism) and myocardial ischemia (acute coronary syndrome, angina). The molecular mechanisms by which anti-cancer therapies lead to cardiotoxicity are diverse and vary according to the specific type of agent used. They include oxidative stress, topoisomerase 2-β inhibition in cardiomyocytes, inflammation, endothelial dysfunction, apoptosis, disruption of Ca2+ homeostasis, mitochondrial dysfunction, DNA damage, increase in various circulating microRNAs levels, alterations in the function of voltage-gated potassium channels. The management of cardiovascular complications in cancer patients is a new challenge for oncologists and cardiologists. Thus the cardio-oncology field has developed the last decade in order to precisely predict and efficiently treat the cancer treatment-related cardiovascular diseases.

Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement.

The discipline of Cardio-Oncology has seen tremendous growth over the past decade. It is devoted to the cardiovascular (CV) care of the cancer patient, especially to the mitigation and management of CV complications or toxicities of cancer therapies, which can have profound implications on prognosis. To that effect, many studies have assessed CV toxicities in patients undergoing various types of cancer therapies; however, direct comparisons have proven difficult due to lack of uniformity in CV toxicity endpoints. Similarly, in clinical practice, there can be substantial differences in the understanding of what constitutes CV toxicity, which can lead to significant variation in patient management and outcomes. This document addresses these issues and provides consensus definitions for the most commonly reported CV toxicities, including cardiomyopathy/heart failure and myocarditis, vascular toxicity, and hypertension, as well as arrhythmias and QTc prolongation. The current document reflects a harmonizing review of the current landscape in CV toxicities and the definitions used to define these. This consensus effort aims to provide a structure for definitions of CV toxicity in the clinic and for future research. It will be important to link the definitions outlined herein to outcomes in clinical practice and CV endpoints in clinical trials. It should facilitate communication across various disciplines to improve clinical outcomes for cancer patients with CV diseases.

Ginger and Heart Health: From Mechanisms to Therapeutics.

As a major cause of morbidity and mortality, cardiovascular diseases (CVDs) are globally increasing. In spite of recent development in the management of cardiovascular complications, CVDs have remained a medical challenge. Numerous conventional drugs are used to play cardioprotective roles; however, they are associated with several side effects. Considering the rich phytochemistry and fewer side effects of herbal medicines, they have gained particular attention to develop novel herbal drugs with cardioprotective potentials. Amongst natural entities, ginger is an extensively used and well-known functional food and condiment, possessing plentiful bioactivities, like anti-inflammatory, antioxidant, and antimicrobial properties in several disorders management. The current review deliberated phytochemical properties as well as the ginger/ginger constituents' biological activities and health benefits in several diseases, with particular attention to cardiovascular complications. A comprehensive search was conducted using multiple databases, including Scopus, PubMed, Medline, Web of Science, national database (Irandoc and SID), and related articles in terms of the health benefits and cardioprotective effects of ginger/ginger constituents. These data were collected from inception until August 2019. In recent years, several herbal medicines were used to develop new drugs with more potency and also minor side effects. Amongst natural entities, ginger is used as a traditional medicine in several diseases. The crude extract, along with related pungent active constituents, is mostly attributed to heart health. The cardioprotective effects of ginger are contributed to its cardiotonic, anti- hypertensive, anti-hyperlipidemia, and anti-platelet effects. The signaling pathways and molecular mechanisms of ginger regarding its cardioprotective effects are also clarified. This study revealed the biological activities, health benefits, and cardioprotective properties of ginger/ginger constituents along with related mechanisms of action, which gave new insights to show new avenues in the treatment of CVDs.

Cardiovascular ultrasound implementation for a pragmatic approach to the diabetic patient

The tailoring of the management of diabetes is the fundamental task of the diabetologist who requires very different skills to guarantee the best diagnostic path and the best treatment for patients. To enrich the range of “measures” necessary for this customization process, it is now possible to use a tool that is now accessible to everyone: the ultrasound machine. Through some simple ultrasound scans, using a minimum amount of time, it is possible to acquire useful information for correct patient stratification and for a rational therapeutic approach, as recommended by the guidelines. The path for the certification of the skills of the diabetologist expert in the management of cardiovascular complications could be the natural context for the placement of these techniques. KEY WORDS diabetes mellitus; cardiovascular complications; tailoring of therapy; echocolordoppler; echocardiography.

THE IMPACT OF QUERCETIN ON THE FUNCTIONAL STATE OF CARDIOVASCULAR SYSTEM AND HEMOSTASE IN RATS WITH TYPE 2 DIABETES MELLITUS

Introduction. Type 2 diabetes mellitus (T2DM) increases the risk for atherosclerotic cardiovascular disease and other cardiovascular complications such as cardiac arrhythmias, heart failure, and thrombotic events. Quercetin (Q) possesses a wide range of multiple activities: anti-diabetic, anti-proliferative, anti-atherosclerotic, antioxidant, anti-inflammatory, anti-thrombotic, anti-apoptotic effects and is regarded as a candidate for the role of cardiovascular complications protecting agent.
 The aim of this study was to assess the effects of Q on the functional state of cardiovascular system and haemostasis in diabetic rats.
 Materials and Methods. T2DM was induced in Wistar rats by a high-caloric diet during 14 weeks combined with intraperitoneal injections of 25 mg/kg streptozotocin twice per week. All diabetic animals were divided into three groups: treated with solvent and with Q (in dose 10 and 50 mg/kg/day per os) for 8 weeks after diabetes induction. Fibrinogen concentration and induced euglobulin fibrinolysis time were measured in plasma using reagent kits. Electrocardiograms were recorded in leads II.
 Results. It was established that Q in dose 50 mg/kg b.w. prevents in the formation of sinus tachycardia in experimental animals. In addition, Q in both doses inhibits the development of myocardial diastolic dysfunction, which was confirmed by prolongation of T-P interval and a decrease of duration of the T wave in comparison with diabetic rats. Q in both doses restorated the processes of coagulations and fibrinolysis, as indicated by a decrease of fibrinogen levels and the time of thrombolysis compared to diabetic rats.
 Conclusions. Q, independently of dose, inhibits the development of myocardial diastolic dysfunction and reduces prothrombotic potential in rats with type 2 diabetes, which may ameliorate diabetic cardiovascular risk. This data justify the perspective of Q for the prevention and management of cardiovascular complications in patients with type 2 diabetes.

The role of flavonoids in the prevention and management of cardiovascular complications: a narrative review.

Cardiovascular diseases (CVDs) are the world's leading cause of death, affecting an estimated 17.9 million people. CVDs have been the primary risk factor for mortality in developed countries. Smoking, hypertension, diabetes, abdominal obesity, psychological stressors, insufficient vegetable and fruit intake could significantly alleviate the burden of disease. The present review sought to document the anti-hypertensive, anti-arrhythmic, anti-anginal, and anti-infarction effects of flavonoids. Cardiovascular disorders are the leading cause of death worldwide, affecting an estimated 17.9 million individuals. Strokes and heart attacks account for 4 out of every 5 deaths caused by cardiovascular disorders. Physical activity protects against a variety of chronic conditions at any age. A demographic program combined with a high-risk CVD prevention approach could dramatically minimize the disease burden in the coming years. By controlling weight and improving the body's use of insulin, physical activity decreases the risk of CVDs. Tobacco and smoking are other modifiable factors associated with the progression of cardiovascular disorders. Abnormal blood lipids are also linked to dietary habits. Daily flavonoid consumption is linked to a lower risk of heart disease. Flavonoids have been the subject of significant interest by experts in recent times due to wide spectrum of possible benefits they provide. polyphenolic compounds can be useful as adjunctive therapy for the management and cure of inflammatory diseases. Literature related to cardiovascular effects of flavonoids was assessed on important database like PubMed, Scopus, ScienceDirect. The outcomes of various studies were documented. Flavonoids are fairly soluble in physiological media and thus are a potential candidate for the possible management of cardiovascular and associated disorders. Alleviating the oxidative stress induced by reactive oxygen species using anti-oxidant-rich flavonoids could lower the chances of platelet hyperactivation, heart disease, discomfort, and fibrosis. Flavonoid intake on a daily basis has been linked to a lower risk of heart failure. Polyphenolic compounds have the ability to be used as an adjunctive therapy in the prevention and control of cardiovascular and inflammatory diseases. Flavonoids have a role in the management of coagulation disorders.

Challenge of post-COVID era: management of cardiovascular complications in asymptomatic carriers of SARS-CoV-2.

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), a highly pathogenic member of family coronaviridae, has caused an exponentially growing global pandemic termed as the coronavirus disease 2019 (COVID-19) with more than 12 million cases worldwide till date. This deadly disease has average fatality rate of 6.5% and even higher among elderly patients and patients with comorbidities. SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE-2) as the entry receptor into host cell. ACE-2, a type-I transmembrane metallocarboxypeptidase, is a critical regulator of the renin-angiotensin system. The entry of SARS-CoV-2 within host cells results in a reduced availability of ACE-2 on the host cell surface followed by significant downregulation of ACE-2 gene expression. As ACE-2 is a well-known cardio-protective molecule, its downregulation could result in severe cardiac disorders. This review deals with a challenging aspect of SARS-CoV-2 infected patients who are asymptomatic or have mild syndromes similar to influenza infections. These patients are proving to be the Achilles’ heel to combat COVID-19 mainly in developing countries of South Asia, where the average number of tests conducted per million individuals is considerably low. Consequently, there is high possibility that individuals with negligible respiratory trouble will not be tested for SARS-CoV-2. Hence, a huge percentage of the population have the risk of developing cardiovascular disorders as a bystander effect of viral infection apart from being potential reservoir of disease transmission. Based on available demographic as well as molecular data, this review predicts a huge spike in cardiovascular disorders among this undetected reservoir in post COVID-19 era.

The Impact of Dialysis Modality on Left Ventricular Function in Patient with End Stage Kidney Disease

Introduction: Cardiovascular disease is frequent in end-stage kidney disease patients, and is a major cause of morbidity and mortality. This study was carried out to assess the comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis on left ventricular function.Methods: A prospective observational study was carried out in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis at least for 6 months. The duration of the study was from June 2019 to May 2020. CAPD consists of 3 to 4 exchanges/day and haemodialysis 2-3 times/week for 4 hours. Baseline characteristics age, gender, dialysis duration, hypertension, diabetes and hyperlipidaemia were collected. The same cardiologist performed all echocardiography at the end of hemodialysis session in hemodialysis patients and after the drain of dialysate in peritoneal dialysis patients.Results: Sixty patients (40 hemodialyses, 20 peritoneal dialyses) were enrolled. The mean age of the patient was 53.71±13.00 years (range 25-76). There was a slightly higher number of male in the hemodialysis group (p= 0.065). Systolic and diastolic blood pressure were significantly higher in hemodialysis groups (p<0.001). Regarding left ventricular parameters, hemodialysis patients had a higher prevalence of left ventricular diastolic dysfunction, left ventricular hypertrophy, left ventricular mass compared to peritoneal dialysis patients. Pericardial effusion and thickening were present higher in hemodialysis patients and was statistically significant (p<0.05).Conclusion: The modality of dialysis influence left ventricular function. Left ventricle dysfunction is prevalent among hemodialysis patients compared to peritoneal dialysis. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.

Experience With Cardiology-Oriented Outcomes in Critically Ill Patients With Coronavirus Disease 2019.

Coronavirus disease 2019 is associated with high mortality rates and multiple organ damage. There is increasing evidence that these patients are at risk for various cardiovascular insults; however, there are currently no guidelines for the diagnosis and management of such cardiovascular complications in patients with coronavirus disease 2019. We share data and recommendations from a multidisciplinary team to highlight our institution's clinical experiences and guidelines for managing cardiovascular complications of coronavirus disease 2019. This was a retrospective cohort study of patients admitted to one of six ICUs dedicated to the care of patients with coronavirus disease 2019 located in three hospitals within one academic medical center in Atlanta, Georgia. Chart review was conducted for sociodemographic, laboratory, and clinical data. Rates of specific cardiovascular complications were assessed, and data were analyzed using a chi-square or Wilcoxon rank-sum test for categorical and continuous variables. Additionally, certain cases are presented to demonstrate the sub committee's recommendations. Two-hundred eighty-eight patients were admitted to the ICU with coronavirus disease 2019. Of these, 86 died (29.9%), 242 (84.03%) had troponin elevation, 70 (24.31%) had dysrhythmias, four (1.39%) had ST-elevation myocardial infarction, eight (2.78%) developed cor pulmonale, and 190 (65.97%) with shock. There was increased mortality risk in patients with greater degrees of troponin elevation (p < 0.001) and with the development of arrhythmias (p < 0.001), cor pulmonale (p < 0.001), and shock (p < 0.001). While there are guidelines for the diagnosis and management of pulmonary complications of coronavirus disease 2019, there needs to be more information regarding the management of cardiovascular complications as well. These recommendations garnered from the coronavirus disease 2019 cardiology subcommittee from our institution will add to the existing knowledge of these potential cardiovascular insults as well as highlight suggestions for the diagnosis and management of the range of cardiovascular complications of coronavirus disease 2019. Additionally, with the spread of coronavirus disease 2019, our case-based recommendations provide a bedside resource for providers newly caring for patients with coronavirus disease 2019.

Type 2 diabetes mellitus is associated with increased arterial stiffness measured by the echo-tracking method

INTRODUCTION: Data for arterial stiffness (АS) in type 2 diabetes mellitus (Т2DM) patients is important for better management of cardiovascular complications and early therapeutic approach. AIM: The aim of this article is to obtain data for pulse wave velocity (PWVβ) and other AS parameters in patients with T2DM without cardiovascular atherosclerotic disease and compare them with controls. MATERIALS AND METHODS: This cross-sectional clinical investigation involves a sample of 100 patients with T2DM without cardiovascular complications and a control group of 30 healthy subjects. In all patients one-point echo-tracking measurement of carotid artery (CA) stiffness with Aloka Prosound α7 machine were conducted and pulse wave velocity (PWVβ), β-stiffness index, arterial compliance (АС), augmentation index (AI), Peterson’s modulus (Ep) were measured. RESULTS AND CONCLUSION: Our results showed the mean value of PWVβ on the left CA (L) in the group of patients with T2DM is 7.37 ± 1.32 m/sec and on the right CA (R) is 7.42 ± 1.33 m/sec. The performed t-test showed statistical significance of the differences of PWVβ (L) and PWVβ (R) in the studied group, compared to the control group (t = 3.764; p = 0.001 and t = 3.561; p = 0.001). The data showed significantly higher values of β-stiffness index (p = 0.001) and Ep (p = 0.001) in patients with T2DM compared to controls. AC was significantly lower in T2DM, when it is measured on the left CA (p = 0.001). AI was significantly higher in T2DM when it is measured on the right CA (p = 0.009). Patients with T2DM are associated with significantly increased AS parameters compared to controls.

Serum lipids in sub clinical hypothyroidism: A retrospective study

Thyroid hormones are a potent regulator of metabolism, playing a crucial role in regulating energy expenditure and in key physiological mechanisms. Their prominent and well-known role is an increase in basal energy expenditure obtained by acting on carbohydrate, protein and lipid-metabolism. Hypothyroidism is relatively common and is associated with an unfavorable effect on lipid metabolism. Few studies reveal subclinical hypothyroidism to be a risk factor for increased incidence of lipid abnormalities and resulting in cardiovascular abnormalities. Hence study was taken up to find the association of serum lipids with subclinical hypothyroidism.This was a retrospective study conducted in the department of Biochemistry, Malla Reddy hospital. Biochemically identified 102 subjects of Subclinical hypothyroidism subjects between 15-50 years and evaluated for lipid profile were included in the study. In our study, the mean serum total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol expressed in mg/dl were 189.98±24.16, 166.48±17.4, 37.62±2.89 and 121.34±27.31mg/dl respectively. 41 subjects out of 102 had higher total cholesterol, triglycerides and LDL cholesterol with lesser HDL cholesterol from the acceptable limits.: We conclude that impaired lipid parameters are associated with subclinical hypothyroidism. Hence a regular screening for lipid profile should be considered in subclinical hypothyroidism for early diagnosis, prevention and management of cardiovascular complications.

Descriptive evaluation of frequent patient referrals to our cardio-oncology clinic: The Mayo experience.

e14018 Background: Cancer survival rates are improving. Therefore, management of cardiovascular complications has now become a crucial clinical concern. Cardio-oncology is the sub-specialty that assists in the overall management of cancer patients in a multi-disciplinary manner. Mayo Clinic cardio-oncology practice was initiated to work closely with our oncology colleagues for early detection of cardiovascular complications in response to cancer-therapy. Majority of the patients visit our cardio-oncology clinic once, we thought it is important to study the group of patients that visited frequently due to cardiovascular complications. Aim: To evaluate the most common cardiovascular complication in patients with 2 or more visits to our cardio-oncology clinic. Methods: From 2012-2017, there were &gt; 2500 patients visits to our clinic, with 24 patients having 2 or more visits. Data including patients’ demographics, ethnicity, chemotherapeutic medications, primary cancer type, cardiovascular risk factors, echocardiography and clinical outcomes were collected. Cardiotoxicity was defined as the decrease in left ventricular ejection fraction (LVEF) of &gt; 10% to a value of &lt; 53%. Heart failure was diagnosed based on Framingham’s criteria or by a cardiologist. Results: There were 19 women (80%) and 5 men (20%). Median age at the time of diagnosis was 56 years [19-76]. The most common malignancy was breast cancer (70%), followed by B-cell lymphoma (12%) and acute myeloid leukemia (8%). Thirty percent had &gt; 2 risk factors for cardiovascular disease. 75% of the patients had an LVEF of &lt; 53, of these 67% developed heart failure with 58% preserved and 42% reduced ejection fraction. Those with heart failure had received a mean anthracycline dose of 305 ± 91.8mg/m2. With initiation of ACEI, B-Blockers, and diuretics (GDMT) 79% showed recovery of LVEF to ≥53 during the follow up. Conclusions: In our experience, most patients who were seen at least twice in the cardio-oncology clinic for heart failure had received a dose of &gt; 300mg/m2 anthracycline. With GDMT over 75% of the patients recovered. Care in the cardio-oncology clinic plays a key role in optimizing these clinical outcomes.

A Survey of the Cardiology Care Delivered to Cancer Patients in Nigeria

BACKGROUND: The incidence of cardiovascular disease is on the rise and this is no less so amongst the population of individuals who are affected by cancer as improvement over the years in cancer treatment options have brought about improved outcomes in terms of overall patient survival and outcomes but has additionally also illuminated the side effects of these cancer treatment as patients live longer to manifest them thereby increasing morbidity and mortality. In Nigeria, there is paucity of data on cardio-oncology and this study will be the first documented study assessing the level of knowledge and the activity of cardiology care provided to oncology patients who develop cardiovascular disease in Nigeria and will therefore serve as a template towards the development of cardio-oncology services in Nigeria. METHODS: The survey was questionnaire-based involving cardiologist in Nigeria. They first part assessed the demographic characteristics of participants. The second part of the questionnaire assessed participants’ self-admitted expertise in the management of cardiovascular conditions complicating cancer treatment. RESULTS: There were more male (57.14%) than female (42.86%) respondents. More than two-thirds of respondents (71.4%, n=55) were aged 30-44 year. Cumulatively, the South-south and South-western regions accounted for over two-thirds of responses (72.43%, n=55). Over three-thirds of respondents (83.12%, n=) worked at teaching hospitals. Majority (89.5%, n=68) of ambulatory cancer patients in need of cardiology care received this service in a general cardiology clinic with only 10.5% (n=8) receiving care at a cardio-oncology centre. Majority of respondents (67.1%, n=51) dId not receive referrals from general practitioners or other specialists to evaluate cardiac problems in patients who had received cancer treatment. 80.5% of participants (n=62) said that they either did not know about the ESC position paper or knew about it but did not apply its suggestions to their practice. CONCLUSION: Most cancer patients requiring cardiovascular care are seen in the general cardiology clinic of Government owned hospitals in Nigeria. Although the knowledge of cardiologists in the management of cardiovascular complications of cancer patients is adequate, referral from General Practitioners is low. The ESC position paper on cardio-oncology is poorly known and utilized by cardiologist in the care of cancer patients with cardiovascular complications with the field of cardio-oncology generally regarded as a new topic in cardiology requiring more information on its dissemination and acceptance. This survey therefore makes obvious the dearth of knowledge regarding cardio-oncology that is prevalent in Nigeria. It is hoped that this will ignite a change in this aspect. There is therefore an urgent need to for all stakeholders to join force together towards the development of cardio-oncology skills and services in Nigeria.

Determination of Some Biochemical Parameters in Streptozotocin-Induced Diabetic Albino Rats Pre-Treated and Post-Treated with Vernonia amygdalina and Gongronema latifolium Extracts

The use of herbs in the management of diabetes mellitus and its complications have been reported. This study was thus aimed at determining the levels of some biochemical parameters in streptozotocin-induced diabetic albino rats pre-treated and post-treated with Vernonia amygdalina and Gongronema latifolium extracts. Fifty (50) albino rats weighing between 150 – 250 g were used for this study. 25 albino rats were used for each phase of the treatment. The pre-treatment phase involved the treatment of the rats with 400 mg/kg b.w (singly) and 200 mg/kg b.w (combined) extracts for 14 days, after which diabetes mellitus was induced using streptozotocin before the rats were sacrificed. The post-treatment phase involved the inducement of diabetes with streptozotocin after which the rats were treated with 400 mg/kg b.w (singly) and 200 mg/kg b.w (combined) extracts for 28 days before the animals were sacrificed. Blood was collected via cardiac puncture and plasma/serum was collected. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), malondialdehyde (MDA), and total antioxidant capacity (TAC) were determined using standard procedures while glucose was measured with a glucometer. Cardiovascular risk ratios such as Castelli risk ratio I and II and atherogenic index of plasma were also calculated. Results showed that extracts of V. amygdalina (only), G. latifolium (only) and V.A+ GL (combined)significantly (p&lt;0.05) reduced the TC, LDL-C , FBS, MDA and TAC levels while HDL-C level significantly (p&lt;0.05) increased. The cardiac risk indices (CRI-I and CRI-II, and Atherogenic index of plasma (AIP) in both the pre-treated and post-treated rats were also reduced when compared to diabetic control. It is thus evident that these plants’ extracts possess hypoglycaemic, hypolipidaemic, and antioxidant properties and thus could be used to reduce cardiovascular risks. Therefore, the tradomedicinal use of these plants in the management of cardiovascular complications is highly recommended.

Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?

Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.

Management of cardiovascular complications in Klinefelter syndrome patients

ABSTRACTIntroduction: Klinefelter syndrome (KS), also known as 47, XXY, shows increased mortality when compared with mortality rates among the general population. Cardiovascular, hemostatic, metabolic diseases are implicated. Moreover, cardiac congenital anomalies in KS can contribute to the increase in mortality.Areas covered: In this study, we have systematically reviewed the relationships between KS and the cardiovascular system and the management of cardiovascular complication. In summary, patients with KS display increased cardiovascular risk profile, characterized by increased prevalence of metabolic alterations including dyslipidemia, diabetes mellitus (DM), and abnormalities in biomarkers of cardiovascular disease. KS subjects are characterized by subclinical abnormalities in endothelial function and in left ventricular (LV) systolic and diastolic function, which – when associated with chronotropic incompetence – may negatively influence cardiopulmonary performance. Moreover, KS patients appear to be at a higher risk for cardiovascular disease, due to thromboembolic events with high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism leading to deep venous thrombosis or pulmonary embolism.Expert opinion: Considering the unequivocal finding of increased mortality of KS patients, we suggest a periodic cardiovascular follow up in specialized centers with multidisciplinary care teams that comprise endocrinologists and cardiologists dedicated to KS syndrome.